State Budget Talking Points: Week of 2/19-23

Message 1: Reject LHCSA contract limits and other managed care-home care actions, cut

  • The Governor’s budget proposes Licensed Home Care Services Agency (LHCSA) contracting limits, as well as a series of other Managed Long Term Care (MLTC) or provider cuts and impacts. These include across-the-board MLTC reimbursement cuts, elimination of MLTC transportation services, and unreimbursed patient acuity changes that would harm or severely set-back the state’s long-term care delivery system. Please work to reject these parts of the budget.
  • These proposals have questionable cost-savings. They offer no detail about the service alternatives for patients who would get disenrolled or transitioned to other services. They micro-manage and constrain the long-term care system’s decision-making ability to arrange vital home care services. And they offer no protections for patients who would be dislocated from their existing in-home caregivers.
  • Such sweeping regulatory, eligibility and systematic proposals like these have no place in a budget discussion.
  • Please reject these adverse actions to the long term care system.

Message 2: Support proportionate home care infrastructure investment and cost-savings initiatives

  • Home care providers deliver a tailored and flexibly executed set of nursing, therapy and aide-level services to patients in their homes, while operating in an environment – the home – that stays with the patient from admission to discharge.
  • Home care, like no other setting, is able to move the dial on health care services volume, efficiently and effectively; but it needs a stable infrastructure to do so.
  • Currently there is only one pool of state resources to support home care and hospice infrastructure to further reconfigure and orient our services toward system goals. It is the “Health Facility Transformation Program,” through which the Governor proposes $425 million in Phase III grants across all settings in this year’s budget.
  • Via state-applied federal waivers, hospital-led entities have received or are set to receive billions in infrastructure funds separate from this pool in order to meet the goals of Value Based Payments and DSRIP.
  • I am asking you to ensure that home care, hospice and other community providers are afforded a dedicated 25% allotment, or $106.25 million, of this Transformation Program pool, consistent with DSRIP, Value Based Payments and other system goals.
  • New York State, through Value Based Payments, wants to reduce volume in health care and lower hospital volume, specifically, by 25%. The existing, licensed home care system is necessary to fulfill these goals and to be the catalyst for transitioning from volume to value across all lines of state Medicaid services.
  • In addition to the 25% funding allotment, the Home Care Association of New York State (HCA) offers some other recommendations to support value-based initiatives in home care by fostering home care’s potential to save costs and improve public health in priority clinical areas. Please review and support these initiatives in HCA’s 2018 Budget and Legislative Asks document.

Message 3: Maintain Home Care Standards for Home Telehealth and other In-Home Services

  • The Governor’s proposed budget includes a provision that would change the standards for delivery of home telehealth services.
  • Licensed and certified home care providers have long been innovators in the use of home telehealth to reduce costs while broadening access to care and life-saving interventions using these technologies.
  • If provided in the home setting, telehealth is currently governed by a set of standards under Article 36 of the public health law that would otherwise apply to the delivery of any other, in-person service at home.
  • Article 36 was adopted to protect patients, ensure appropriate oversight of home care services, and to establish standards of care in the home care setting. These standards and protections should apply regardless of whether the service is delivered in-person or remotely by a telehealth care manager employed by a licensed home care agency.
  • I urge you to modify this telehealth proposal to ensure that services currently limited to home care providers are not circumvented by non‐home care providers attempting to use telehealth.